Reducing the environmental impact of surgery on a global scale: systematic review and co-prioritization with healthcare workers in 132 countries

Background Healthcare cannot achieve net-zero carbon without addressing operating theatres. The aim of this study was to prioritize feasible interventions to reduce the environmental impact of operating theatres. Methods This study adopted a four-phase Delphi consensus co-prioritization methodology. In phase 1, a systematic review of published interventions and global consultation of perioperative healthcare professionals were used to longlist interventions. In phase 2, iterative thematic analysis consolidated comparable interventions into a shortlist. In phase 3, the shortlist was co-prioritized based on patient and clinician views on acceptability, feasibility, and safety. In phase 4, ranked lists of interventions were presented by their relevance to high-income countries and low–middle-income countries. Results In phase 1, 43 interventions were identified, which had low uptake in practice according to 3042 professionals globally. In phase 2, a shortlist of 15 intervention domains was generated. In phase 3, interventions were deemed acceptable for more than 90 per cent of patients except for reducing general anaesthesia (84 per cent) and re-sterilization of ‘single-use’ consumables (86 per cent). In phase 4, the top three shortlisted interventions for high-income countries were: introducing recycling; reducing use of anaesthetic gases; and appropriate clinical waste processing. In phase 4, the top three shortlisted interventions for low–middle-income countries were: introducing reusable surgical devices; reducing use of consumables; and reducing the use of general anaesthesia. Conclusion This is a step toward environmentally sustainable operating environments with actionable interventions applicable to both high– and low–middle–income countries

Reducing the environmental impact of surgery on a global scale: systematic review and co-prioritization with healthcare workers in 132 countries

Abstract Background Healthcare cannot achieve net-zero carbon without addressing operating theatres. The aim of this study was to prioritize feasible interventions to reduce the environmental impact of operating theatres. Methods This study adopted a four-phase Delphi consensus co-prioritization methodology. In phase 1, a systematic review of published interventions and global consultation of perioperative healthcare professionals were used to longlist interventions. In phase 2, iterative thematic analysis consolidated comparable interventions into a shortlist. In phase 3, the shortlist was co-prioritized based on patient and clinician views on acceptability, feasibility, and safety. In phase 4, ranked lists of interventions were presented by their relevance to high-income countries and low–middle-income countries. Results In phase 1, 43 interventions were identified, which had low uptake in practice according to 3042 professionals globally. In phase 2, a shortlist of 15 intervention domains was generated. In phase 3, interventions were deemed acceptable for more than 90 per cent of patients except for reducing general anaesthesia (84 per cent) and re-sterilization of ‘single-use’ consumables (86 per cent). In phase 4, the top three shortlisted interventions for high-income countries were: introducing recycling; reducing use of anaesthetic gases; and appropriate clinical waste processing. In phase 4, the top three shortlisted interventions for low–middle-income countries were: introducing reusable surgical devices; reducing use of consumables; and reducing the use of general anaesthesia. Conclusion This is a step toward environmentally sustainable operating environments with actionable interventions applicable to both high– and low–middle–income countries

Secondary diaphragmatic eventration after resection of extralobar pulmonary sequestration

Phrenic nerve preservation is an important factor in operations involving the resection of an extralobar pulmonary sequestration. We present a case of secondary diaphragmatic eventration due to damage to the phrenic nerve after resection of an extralobar pulmonary sequestration

Case Report - Secondary diaphragmatic eventration after resection of extralobar pulmonary sequestration

Phrenic nerve preservation is an important factor in operations involving the resection of an extralobar pulmonary sequestration. We present a case of secondary diaphragmatic eventration due to damage to the phrenic nerve after resection of an extralobar pulmonary sequestration

Postoperative intestinal obstruction after laparoscopic versus open surgery in the pediatric population: A 15-year review

Purpose: The aim of the study was to determine the possible advantages of a laparoscopic approach versus open surgery in infants and children with regard to the development of post-operative intestinal obstruction (PIO). Material and Methods: A retrospective study was performed. The medical records of all infants and children who underwent an abdominal operation in our department between 1992 and 2007 were included. Data included initial diagnosis, age at initial operation, initial surgical approach, time to PIO, and type of definitive treatment. Results: From 1992 to 2007, a total of 3600 abdominal operations were performed in our institution. As not all types of operations can be performed using a laparoscopic approach, in order to obtain a more exact result we compared only operations of the same type performed either by laparoscopy or laparotomy in this period. A total of 2 243 comparable abdominal operations were performed, of which 1558 (69.46%) were performed using a laparoscopic approach and 685 (30.54%) were performed by laparotomy. Postoperative intestinal obstruction (PIO) was diagnosed in 36 cases. In 14 of these patients (38.88%), the initial operation was performed via a laparoscopic approach, while the remaining 22 (61.12%) were initially operated using laparotomy. Overall, 0.89% of the patients initially managed by laparoscopy and 3.21 % of the patients initially treated by laparotomy were treated for postoperative intestinal obstruction (p < 0.0001). Conclusion: Abdominal surgery via a laparoscopic approach reduces the likelihood of PIO development. The risk for re-operation after development of PIO in infants and children is significantly higher in patients initially treated by laparotomy than for patients treated by laparoscopy. © Georg Thieme Verlag KG Stuttgart

Evaluation of the appendix during diagnostic laparoscopy, the laparoscopic appendicitis score:a pilot study

<p>Diagnostic laparoscopy is the ultimate diagnostic tool to evaluate the appendix. Still, according to the literature, this strategy results in a negative appendectomy rate of approximately 12-18 % and associated morbidity. Laparoscopic criteria for determining appendicitis are lacking. The goal of this study is to define clear and reliable criteria for appendicitis during diagnostic laparoscopy that eventually may safely reduce the negative appendectomy rate.</p><p>From December 2009 through April 2011, 134 patients were included and analysed in a single-centre prospective pilot study. Intraoperatively, the appendix was evaluated by the surgeon according to nine criteria for appendicitis. The operating surgeon decided whether it should be removed or not. Immediately after the operation the surgeon had to complete a questionnaire on nine criteria for appendicitis. All removed appendices were examined by a pathologist. In case the appendix was not removed, the clinical postoperative course was decisive for the (missed) presence of appendicitis.</p><p>In 109 cases an inflamed appendix was removed; in 25 patients the appendix was normal, 3 of which had been removed. After univariate analysis and clinical judgement six variables were included in the Laparoscopic APPendicitis score (LAPP score). In this study, use of the LAPP score would have led to a positive predictive value of 99 % and a negative predictive value of 100 %.</p><p>This study presents the LAPP score. The LAPP score is an easily applicable score that can be used by surgeons to evaluate the appendix during diagnostic laparoscopy. The score has high positive and negative predictive value. The LAPP score needs to be validated in a multicentre validation study.</p>